title: Cognitive impairment and antiphospholipid syndrome: is paradoxical embolism the rule?
abstract: OBJECTIVE
  Although cognitive decline (CD) is described in antiphospholipid syndrome (APS), its physiopathology is unknown. Paradoxical embolization (PE) is related to CD in Alzheimer disease. The objective of this study was to determine whether PE plays a role in CD in APS patients through a significant right-to-left shunt (sRLS).
  
  
  METHODS
  A total of 27 patients diagnosed with APS without a history of stroke were tested for the presence of an sRLS using a contrast-enhanced transcranial Doppler (cTCD) ultrasound. Cognitive decline was assessed using the mini mental state examination (MMSE), the Montreal cognitive assessment (MoCA), and a battery of neuropsychological tests.
  
  
  RESULTS
  Of the 27 patients, 19 (70%) had a non-sRLS condition (≤ 10 high-intensity transient signs [HITS] on cTCD), and 8 (30%) had an sRLS. Patients with more than 10 years of scholarship performed significantly better on both the MMSE (P = 0.048) and MoCA (P = 0.03). Individuals of the non-sRLS group with more than 10 years of scholarship had better performances on the five-point test (FPT) when compared with the sRLS group (P = 0.01).
  
  
  CONCLUSIONS
  Patients without sRLS and with more years of education exhibited a better performance in cognitive tests than sRLS patients.
authors.affiliation: Hospital de Clínicas from Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Zamproni
authors.forename: Mauren C S
authors.initials: MC
authors.lastname: Rubert
authors.forename: Viviane F
authors.initials: VF
authors.lastname: Zétola
authors.forename: Maria Joana
authors.initials: MJ
authors.lastname: Mader-Joaquim
authors.forename: Marcos C
authors.initials: MC
authors.lastname: Lange
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D004522:Educational Status; D019320:Embolism, Paradoxical / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013647:Task Performance and Analysis; D017585:Ultrasonography, Doppler, Transcranial